Government estimate reflects failure of prevention, critics say

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This file photo shows a red AIDS ribbon emblazoned on the United Nations Secretariat Building in New York. For the first time since the height of the AIDS epidemic in the 1980s, more than a million Americans are believed to be living with the virus that causes AIDS.

ATLANTA — For the first time since the height of the AIDS epidemic in the 1980s, more than a million Americans are believed to be living with the virus that causes AIDS, the government said Monday.

The latest estimate is both good and bad news — reflecting the success of drugs that keep more people alive and the failure of the government to “break the back” of the AIDS epidemic by its stated goal of 2005.

Critics say the new estimate reflects a failure of prevention, and it comes in the year that the government had set as its deadline to “break the back” of the AIDS epidemic.

The Centers for Disease Control and Prevention said that between 1,039,000 and 1,185,000 people in the United States were living with HIV in December 2003. The previous estimate — released in 2002 — showed that between 850,000 and 950,000 people had the AIDS virus.

The jump reflects the role of medicines that have allowed people infected with the virus to live longer, said Dr. Ronald Valdiserri, deputy director of the CDC’s National Center for HIV, STD and TB Prevention.

“While treatment advances have been an obvious godsend to those living with the disease, it presents new challenges for prevention,” Valdiserri said.

60,000 new cases a year?The challenges include overcoming a failure by the government to meet its 2005 goal of cutting in half the estimated 40,000 new HIV infections that have occurred every year since the 1990s. Then, Dr. Robert Janssen of the CDC pledged the government campaign would “break the back” of the epidemic.

CDC officials previously have said the country’s HIV infection rate has been “relatively stable” and without change. As the National HIV Prevention Conference was set to begin this week, Valdiserri said no new infection data will be available until next year.

However, recent outbreaks of HIV and sexually transmitted diseases in major cities around the country offer a hint that new infections may be as high as 60,000 cases a year, rather than the government estimate of 40,000, said Dr. Carlos del Rio, an Emory University professor of medicine.

“The U.S. has had a clear failure in HIV prevention — I think the increase in prevalence is a reflection of that, of the poor job we do in HIV prevention,” del Rio said.

He added that the higher number is not as surprising as why the country has not been able to curb new infections. He said the CDC hasn’t been given adequate resources to tackle HIV prevention and that experts have focused too much on whether it’s better to promote abstinence or condom use to stop the spread of the virus.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

“We’re debating too much what to do and are not doing enough,” he said.

At the same time, reaching the 1 million mark is “a sign of both victory and failure,” said Terje Anderson, executive director of the National Association of People Living With AIDS.

“Part of the reason the number is so big is we’re not dying as before,” he said. “But the other problem is we have not made a significant dent in new infections.”

47 percent are black
Estimating the number of Americans with HIV has always been a difficult task for health officials, but this year’s figures are believed to be the most accurate ever thanks to wider case reporting.

Estimating the number of Americans with HIV has always been a difficult task for health officials. In the 1990s, the CDC and other agencies generally agreed that between 600,000 and 900,000 people had the virus, according to the University of California-San Francisco’s Center for HIV Information.

Previous estimates — as high as 1.5 million people — from the 1980s were later determined to be too high. For example, the CDC estimated in 1986 that between 1 million and 1.5 million people had HIV. In 1987, that was revised to 945,000 to 1.4 million and was refined in 1990 to 800,000 to 1.2 million.

Since the CDC’s previous HIV estimates didn’t include demographic information — age, gender, race, sexual orientation — for all 50 states, it’s impossible to determine what groups of people account for the increase in the latest estimate of people living with HIV.

However, the CDC estimates that blacks account for 47 percent of HIV cases; gay and bisexual men make up 45 percent of those living with the virus that causes AIDS, the health agency believes.

The CDC also warned those demographics may soon change because heterosexual blacks, women and others infected after having high-risk sex (such as with someone with HIV, an injection-drug user or a man who has sex with other men) now account for a larger proportion of those living with HIV than those who are living with full-blown AIDS.